Implantable cardioverter-defibrillators — is defibrillation efficacy testing still necessary?

Test defibrylacji (DT) od ponad 20 lat stanowił integralną część procedury implantacji wszczepialnych kardiowerterów- -defibrylatorów (ICD). Indukcja migotania komór w czasie DT ma na celu potwierdzenie adekwatnego marginesu bezpieczeństwa pomiędzy maksymalną energią generowaną przez ICD, a energią defibrylacji wymaganą dla przerwania zagrażających życiu arytmii komorowych. Aktualnie postęp technologiczny sprawił, że skuteczność kliniczna terapii antyarytmicznej ICD sięga 90% co wpływa na stały trend do rezygnacji z wykonywania DT. Tematem artykułu są aktualne pytania związane z problemem podwyższonego progu defibrylacji (DFT) oraz koniecznością i bezpieczeństwem dalszego rutynowego wykonywania DT.Defibrillation testing (DT) has been an integral component of implantable cardioverter-defibrillator (ICD) implantation procedure for over the last 20 years. The induction of ventricular fibrillation (VF) during the DT is the accepted method to determine a sufficient safety margin between the maximum shock energy of the ICD and the shock energy required for defibrillation life threatening ventricular arrhythmias. Nowadays, ICD technology has evolved and the likelihood of successful VF defibrillation achieved 90%, which determines a trend toward ICD implantation without DT. The topic of this article are questions and answers concerning the problems with elevated defibrillation threshold and the appropriateness and safety of routine intraoperative DT

Internal medicine? Personal reminiscenses from the 20th century

Medicine, in the ancient time an empirical, often mysterious knowledge, aimed to help suffering people. It developed quickly and massively entering the way of scientific research in the last few centuries. Recently, it has shifted from natural towards social sciences to fulfill the demands and expectations of societies. Highly sophisticated and expensive tools and very complicated health care systems result in continuous reforms in teaching professionals. The inadequately controlled progress in medical practice creates dangers to social health and safety, surprisingly raising dissatisfaction and mass contestation. Such situation generates the need for reasonable health policy in steering scientific research to the most burning social problems instead to those most ambitious, fascinating, and promising biggest financial profit. That is why energetic movements for high level of ethics in scientific research and among health care professionals has been called for all over the world. Further development in medical sciences and progress in medical practice will certainly continue and both are highly desirable, however they should never disregard the rank of social needs which in various countries may be different